Abstract 13974: Hospital-Level Variation in Delays to Clopidogrel Filling Following Stent Implantation and Short-Term Cardiovascular Outcomes: Insights from the National VA Clinical Assessment, Reporting, and Tracking (CART) Program
Background: A prior study found ∼16% of patients delay filling clopidogrel after hospital discharge following coronary artery stent implantation and this delay was associated with adverse outcomes. We investigated, at the hospital level, variability in proportion of patients who delay filling a clopidogrel prescription following hospital discharge from stent implantation. Moreover, we assessed whether hospitals with higher proportion of patients with delays were associated with adverse outcomes.
Methods: We used the VA's national CART cath lab database to obtain all PCIs with stents performed between 10/01/08 and 9/30/09 at all 60 VA cath labs. Using pharmacy fill data, we summarized the proportion of patients with no recent clopidogrel prescription (N=14,910 patients) and who delayed filling, defined as > 1 day after discharge for each hospital. Next, we divided hospitals into quartiles based on proportion of patients with delays at each hospital and assessed the association with myocardial infarction (MI) up to 3 months following the procedure.
Results: The mean age of patients undergoing PCI with a stent was 64.6 years, 76.2% received a drug-eluting stent, and 34.8% of the procedures were performed for MI. Each hospital performed a mean 248.5 PCIs with median of 180.5 (IQR 128-288.5). The mean proportion of patients per hospital with delay was 6.7% (median 4.9%, IQR 2.9%−8.9%), with mean delay of 6.8 ± 6.0 days. There was a trend towards increased risk of MI among hospitals with higher proportions of patients with delays (P=0.035 for trend, Figure; OR 3.6, 95% CI 0.57-155 for comparison between quartile 1 and 4).
Conclusions: There is considerable variation at hospitals in the proportion of patients who delay filling a clopidogrel prescription. Hospitals with higher proportions of patients with clopidogrel delay also had higher associated rates of short-term MI. Hospital-level interventions may be needed to reduce clopidogrel delays following stent implantation.
- © 2011 by American Heart Association, Inc.